胸椎旁神经阻滞治疗难治性心绞痛疗效的网状Meta分析

Effectiveness of paravertebral block in the treatment of patients with refractory angina pectoris ： a systematic review and network Meta-analysis

目的采用网状Meta分析方法比较胸椎旁神经阻滞等11种方法治疗难治性心绞痛的疗效。方法检索Pubmed、Springer、Medline、Embase、中国期刊全文数据库及万方数据库，收集安慰剂、地尔硫卓，曲美他嗪、地尔硫卓联合曲美他嗪、体外反搏（ECP）、普萘洛尔、体外反搏联合丹红注射液、硝苯地平、硝酸甘油、胸椎旁神经阻滞（PVB）和星状神经节阻滞（SGB）共11种方法治疗难治性心绞痛的随机对照试验（RCTs）。采用STATA12．0和Win—BUGSl．4．3软件进行网状Meta分析，采用比值比（OR）作为有效率的衡量指标。结果最终11篇研究纳入网状Meta分析，结果显示：胸椎旁神经阻滞与其他10种治疗方法（除安慰剂外）之间的差异有统计学意义（OR值分别为0．73，0．74，0．62，0．94，0．83，0．82，0．83，0．83，1．03）。结论对于难治性心绞痛患者，胸椎旁神经阻滞比其他10种治疗方法更有效。

Objective To evaluate the efficacy of paravertebral block in the treatment of refractory angina pectoris（RAP）with Meta-analysis. Methods The databases of PubMed,Springer, Medline,EMBase, Cochrane Library, and WanFang Database were retrieved with computer for collecting randomized controlled trials （RCT） about 11 treatment strategies for RAP： placebo, diltiazem, trimetazidine, diltiazem plus trimetazidine, external counterpulsation （ ECP）, propranolol, ECP plus Danhong injection, nifedipine, glyeeryl trinitrate, paravertebral block （PVB） , and stellate ganglion block （SGB）. The odds ratios （OR） for each outcome were analyzed by STATA 12.0 and Win-BUGS1.4.3. Results 11 RCTs were included in the network Meta-analysis. Paravertebral block, SGB, ECP plus Danhong injection, and dihiazem were significantly more efficacious than ECP （odds ratios [OR] 0.94,0.99,0.94 and 1.01, respectively）, diltiazem plus trimetazidine （0.62,0.61,0.85 and 1.13, respectively） , propranolol （0.83,0.82,0.69 and 1.38, respectively） , nifedipine （ 0.83,0.82, 1.82 and 1.70, respectively）, glyceryl trinitrate （0.83,0.81,1.56 and 1.44, respectively） , and trimetazidine （0.74,0.72, 0.61 and 1.76, respectively）. Paravertebral block was significantly more efficacious than the other 10 treatment strategies for RAP patients. Conclusion Paravertebral block had a better effectiveness than the other 10 treatment for the treatment of patient with refractory angina pectoris.